Using latent class and quantum models to value equity in health care: a tale of 2 stories

Cost-effectiveness analysis (CEA) with quality-adjusted life-year (QALY) was introduced to address health equity concerns in value assessment. However, QALY fails to capture patient preference. Stated preference methods (eg, discrete choice experiment [DCE]) have been increasingly used to incorporate patient preference into the value assessment framework in health care. Still, ones with a moral dimension such as health equity do not exist. The objective of this paper was to describe 2 stated preference approaches that can empirically value health equity. First, the decision-maker perceptions of the prevalence of equity dimensions in DCE choice tasks are identified. A latent class model based on random utility theory is proposed to derive the value of equity from the decision makers with different perceptions of the prevalence of equity dimensions. Second, equity attributes are incorporated in DCE choice tasks, and a quantum choice model, which can capture stochasticity during the decision process in the mind of the decision makers, is used to value the equity. These approaches will improve existing value assessment methods to address health equity adequately.